Osnat Nir1,2, Firas Rinawi1,2, Gil Amarilyo1,2, Liora Harel1,2, Raanan Shamir1,2, Amit Assa3,4. 1. From the Sackler School of Medicine, Tel Aviv University, Tel Aviv; Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; Rheumatology Unit, Schneider Children's Medical Center, Petach Tikva, Israel. 2. O. Nir, Medical Student, Sackler School of Medicine; F. Rinawi, MD, Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; G. Amarilyo, MD, Sackler School of Medicine, and Rheumatology Unit, Schneider Children's Medical Center; L. Harel, MD, Sackler School of Medicine, and Rheumatology Unit, Schneider Children's Medical Center; R. Shamir, MD, Sackler School of Medicine, and Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; A. Assa, MD, MHA, Sackler School of Medicine, and Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center. For O. Nir, this work was performed in partial fulfillment of the MD thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University. 3. From the Sackler School of Medicine, Tel Aviv University, Tel Aviv; Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; Rheumatology Unit, Schneider Children's Medical Center, Petach Tikva, Israel. dr.amit.assa@gmail.com. 4. O. Nir, Medical Student, Sackler School of Medicine; F. Rinawi, MD, Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; G. Amarilyo, MD, Sackler School of Medicine, and Rheumatology Unit, Schneider Children's Medical Center; L. Harel, MD, Sackler School of Medicine, and Rheumatology Unit, Schneider Children's Medical Center; R. Shamir, MD, Sackler School of Medicine, and Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center; A. Assa, MD, MHA, Sackler School of Medicine, and Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center. For O. Nir, this work was performed in partial fulfillment of the MD thesis requirements of the Sackler Faculty of Medicine, Tel Aviv University. dr.amit.assa@gmail.com.
Abstract
OBJECTIVE: The natural history of pediatric inflammatory bowel disease (IBD) patients with joint involvement has not been clearly described. Thus, we aimed to investigate phenotypic features and clinical outcomes of this distinct association. METHODS: The medical records of patients with pediatric IBD diagnosed from 2000 to 2016 were reviewed retrospectively. Main outcome measures included time to first flare, hospitalization, surgery, and biologic therapy. RESULTS: Of 301 patients with Crohn disease (median age 14.2 yrs), 37 (12.3%) had arthritis while 44 (14.6%) had arthralgia at diagnosis. Arthritis and arthralgia were more common in women (p = 0.028). Patients with arthritis and arthralgia demonstrated lower rates of perianal disease (2.7% and 4.5% vs 16.9%, p = 0.013), whereas patients with arthritis were more likely to be treated with biologic therapy (HR 2.05, 95% CI 1.27-3.33, p = 0.009). Of 129 patients with ulcerative colitis (UC; median age 13.7 yrs), 3 (2.3%) had arthritis and 16 (12.4%) had arthralgia at diagnosis. Patients with arthralgia were treated more often with corticosteroids (p = 0.03) or immunomodulator therapies (p = 0.003) compared with those without joint involvement. The likelihood to undergo colectomy was significantly higher in patients with arthralgia (HR 2.9, 95% CI 1.1-7.4, p = 0.04). During followup (median 9.0 yrs), 13 patients developed arthritis (3.3%). Arthralgia at diagnosis was a significant predictor for the development of arthritis during followup (HR 9.0, 95% CI 2.86-28.5, p < 0.001). CONCLUSION: Pediatric IBD patients with arthritis have distinct phenotypic features. Arthralgia at diagnosis is a predictor for colectomy in UC and a risk factor for the development of arthritis during followup.
OBJECTIVE: The natural history of pediatric inflammatory bowel disease (IBD) patients with joint involvement has not been clearly described. Thus, we aimed to investigate phenotypic features and clinical outcomes of this distinct association. METHODS: The medical records of patients with pediatric IBD diagnosed from 2000 to 2016 were reviewed retrospectively. Main outcome measures included time to first flare, hospitalization, surgery, and biologic therapy. RESULTS: Of 301 patients with Crohn disease (median age 14.2 yrs), 37 (12.3%) had arthritis while 44 (14.6%) had arthralgia at diagnosis. Arthritis and arthralgia were more common in women (p = 0.028). Patients with arthritis and arthralgia demonstrated lower rates of perianal disease (2.7% and 4.5% vs 16.9%, p = 0.013), whereas patients with arthritis were more likely to be treated with biologic therapy (HR 2.05, 95% CI 1.27-3.33, p = 0.009). Of 129 patients with ulcerative colitis (UC; median age 13.7 yrs), 3 (2.3%) had arthritis and 16 (12.4%) had arthralgia at diagnosis. Patients with arthralgia were treated more often with corticosteroids (p = 0.03) or immunomodulator therapies (p = 0.003) compared with those without joint involvement. The likelihood to undergo colectomy was significantly higher in patients with arthralgia (HR 2.9, 95% CI 1.1-7.4, p = 0.04). During followup (median 9.0 yrs), 13 patients developed arthritis (3.3%). Arthralgia at diagnosis was a significant predictor for the development of arthritis during followup (HR 9.0, 95% CI 2.86-28.5, p < 0.001). CONCLUSION: Pediatric IBD patients with arthritis have distinct phenotypic features. Arthralgia at diagnosis is a predictor for colectomy in UC and a risk factor for the development of arthritis during followup.
Authors: Jeffrey M A van der Krogt; F Verkuil; E Charlotte van Gulik; Robert Hemke; J Merlijn van den Berg; Dieneke Schonenberg-Meinema; Angelika Kindermann; Koert M Dolman; Marc A Benninga; Taco W Kuijpers; Mario Maas; Charlotte M Nusman Journal: Rheumatol Int Date: 2021-11-22 Impact factor: 3.580
Authors: Neera Gupta; Robert H Lustig; Howard Andrews; Ranjana Gokhale; Alka Goyal; Ashish S Patel; Stephen Guthery; Francisco Sylvester; Leah Siebold; Cheng-Shiun Leu Journal: Inflamm Bowel Dis Date: 2021-05-17 Impact factor: 7.290